MedPath

Safety and Quality of Life Study of Aflibercept in Patients With Metastatic Colorectal Cancer Previously Treated With an Oxaliplatin-Based Regimen

Phase 3
Completed
Conditions
Colorectal Cancer Metastatic
Interventions
Registration Number
NCT01571284
Lead Sponsor
Sanofi
Brief Summary

Primary Objective:

To provide metastatic colorectal cancer participants with access to aflibercept and to document the overall safety in these participants

Secondary Objective:

To document the Health-Related Quality of Life of aflibercept in this participants population

Detailed Description

Each participants will be treated until disease progression, unacceptable toxicity, death, Investigator's decision or participant's refusal for further treatment (whichever comes first). Participants were followed-up during study treatment and for at least 30 days after last administration.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
781
Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
Aflibercept + FOLFIRI (Irinotecan, 5-FU & Leucovorin)AFLIBERCEPT AVE0005Aflibercept 4 mg/kg IV infusion over 60 minutes followed by Irinotecan 180 mg/m\^2 IV infusion over 90 minutes and Leucovorin 400 mg/m\^2 IV infusion over 120 minutes at the same time followed by 5-Fluorouracil (5-FU) 400 mg/m\^2 IV bolus over 2-4 minutes followed by 5-FU 2400 mg/m\^2 continuous IV infusion over 46 hours on Day 1 of each cycle (1 Cycle = 2 weeks), until disease progression (DP), unacceptable toxicity, death, Investigator's decision or participant's refusal of further treatment.
Aflibercept + FOLFIRI (Irinotecan, 5-FU & Leucovorin)FOLFIRIAflibercept 4 mg/kg IV infusion over 60 minutes followed by Irinotecan 180 mg/m\^2 IV infusion over 90 minutes and Leucovorin 400 mg/m\^2 IV infusion over 120 minutes at the same time followed by 5-Fluorouracil (5-FU) 400 mg/m\^2 IV bolus over 2-4 minutes followed by 5-FU 2400 mg/m\^2 continuous IV infusion over 46 hours on Day 1 of each cycle (1 Cycle = 2 weeks), until disease progression (DP), unacceptable toxicity, death, Investigator's decision or participant's refusal of further treatment.
Primary Outcome Measures
NameTimeMethod
Number of Participants With Abnormal Renal and Liver Function ParametersBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Renal and liver function parameters included: creatinine, hyperbilirubinemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase. Number of participants with each of these parameters were analyzed by grades (All Grades and Grades 3-4) as per NCI CTCAE version 4.03, where Grade 1=mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling. All Grades included Grades 1-4.

Number of Participants With Treatment-Emergent Adverse Events (TEAEs)Baseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Any untoward medical occurrence in a participant who received investigational medicinal product (IMP) was considered an adverse event (AE) without regard to possibility of causal relationship with this treatment. A serious AE (SAE): Any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious AEs. National Cancer Institute Common Terminology Criteria (NCI-CTCAE) Version 4.03 was used to assess severity (Grade 1=mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling) of AEs.

Number of Participants With Abnormal Hematological ParametersBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Abnormal hematological parameters included: anaemia, thrombocytopenia, leukopenia and neutropenia. Number of participants with each of these parameters were analyzed by grades (All Grades and Grades 3-4 as per NCI CTCAE (Version 4.03), where Grade 1=mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling. All Grades included Grades 1-4.

Number of Participants With International Normalized Ratio (INR)Baseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

The INR is a derived measure of the prothrombin time. The INR is the ratio of a participant's prothrombin time to a normal control sample. Normal range (without anti coagulation therapy): 0.8-1.2; Targeted range (with anti coagulation therapy) 2.0-3.0.

Number of Participants With Abnormal Electrolytes ParametersBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Abnormal electrolytes parameters included: hyponatremia, hypernatremia, hypocalcemia, hypercalcemia, hypokalemia, and hyperkalemia. Number of participants with each of these parameters were analyzed by grades ( All Grades and Grades 3-4 as per NCI CTCAE Version 4.03, where Grade 1=mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling. All Grades included Grades 1-4.

Creatinine Clearance of Aflibercept Plus FOLFIRIBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Creatinine clearance is a measure of kidney function. Creatinine clearance rate is the volume of blood plasma that is cleared of creatinine by the kidneys per unit time. Creatinine clearance can be measured directly or estimated using established formulas. For this study, the creatinine clearance was calculated using the Cockroft-Gault or Modification of Diet in Renal Disease (MDRD).

Number of Participants With Other Abnormal Biochemistry ParametersBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Other abnormal biochemistry parameters included: hypoglycemia, hyperglycemia and hypoalbuminemia. Number of participants with each of these parameters were analyzed by grades (All Grades and Grades 3-4) as per NCI CTCAE Version 4.03, where Grade 1= mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling. All Grades included Grades 1-4.

Number of Participants With Cycle Delay and/or Dose ModificationBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

A theoretical cycle is a 2 week period i.e. 14 days. A cycle is delayed if duration of previous cycle is greater than 14+2 days ; dose modification includes dose reduction and dose omission.

Number of Participants With Abnormal Non-Gradable Biochemistry ParametersBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Non-gradeable biochemistry parameters included; chloride, urea, total protein, blood urea nitrogen (BUN) and lactate dehydrogenase (LDH). Number of participants with \<lower limit of normal ranges (LLN) and \>upper limit of normal ranges (ULN) for each of these parameters were reported.

Number of Participants With Proteinuria Grade >=2Baseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Proteinuria is defined as the ratio of protein to creatinine. Number of participants with proteinuria grade \>=2 (graded as per NCI CTCAE Version 4.03), where Grade\>=2 represents moderate to life-threatening/disabling event.

Number of Participants With Proteinuria EventsBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Proteinuria is defined as the ratio of protein to creatinine. Number of participants with proteinuria were analyzed by grades (Grades 1, 2, 3 ,4) as per NCI CTCAE Version 4.03 where Grade 1= mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening/disabling.

Number of Participants With Urinary Protein-Creatinine Ratio (UPCR)Baseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Urinary protein creatinine ratio (UPCR) corresponds to the ratio of the urinary protein and urinary creatinine concentration (expressed in mg/dL). This ratio provides an accurate quantification of 24-hours urinary protein excretion. There is a high correlation between morning UPCR and 24-hour proteinuria in participants with normal or reduced renal functions. Normal ratio is \< or = 1.

Number of Participants With Proteinuria (Grade>=2) Concomitant With Hematuria and /or HypertensionBaseline up to 30 days after the last treatment administration (either Aflibercept or FOLFIRI whichever comes last) (maximum exposure: 214 weeks)

Proteinuria is defined as the presence of excess proteins in the urine (assessed either by spot sample, dipstick/ urine protein or 24 hour urine collection). Hematuria is defined as the presence of blood in urine (positive dipstick for RBC or reported AE). Number of participants with proteinuria grade \>=2 (graded as per NCI CTCAE Version 4.03), where Grade\>=2 represents moderate to life-threatening/disabling event. Hypertension (high blood pressure) is defined as having a blood pressure reading of more than 140/90 mmHg over a number of weeks.

Secondary Outcome Measures
NameTimeMethod
Mean Change From Baseline in Health Related Quality of Life (HRQL) European Organization for Research and Treatment for Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30 Score): Global Health StatusPre-dose at Baseline, Day 1 of every odd cycle (from Cycle 3 to 35); at the end of treatment (EOT) (within 30 days of last treatment) (maximum exposure: 214 weeks)

EORTC-QLQ-C30 is a cancer-specific instrument with 30 questions for evaluation of new chemotherapy and provides an assessment of participant reported outcome dimensions. First 28 questions used 4-point scale (1=not at all,2=a little,3=quite a bit,4=very much) for evaluating 5 functional scales (physical,role,emotional,cognitive,social), 3 symptom scales (fatigue,nausea/vomiting,pain) \& other single items. For each item,high score represented high level of symptomatology/problem. Last 2 questions represented participant's assessment of overall health \& quality of life, coded on 7-point scale (1=very poor to 7=excellent).EORTC QLQ-C30 observed values and change from baseline for global health status (scoring of questions 29 \& 30) and 5 functional scales, 3 symptom scales and other single items (scoring of questions 1 to 28). Answers were converted into grading scale, with values between 0 and 100. A high score represented a favourable outcome with a best quality of life for participant.

Change From Baseline in HRQL EORTC QLQ-C30 Score: Symptom ScalesPre-dose at Baseline, Day 1 of every odd cycle (from Cycle 3 to 35); at EOT (within 30 days of last treatment) (maximum exposure: 214 weeks)

EORTC-QLQ-C30 is a cancer-specific instrument with 30 questions for evaluation of new chemotherapy and provides an assessment of participant reported outcome dimensions. First 28 questions used 4-point scale (1=not at all,2=a little,3=quite a bit,4=very much) for evaluating 5 functional scales (physical,role,emotional,cognitive,social), 3 symptom scales (fatigue,nausea/vomiting,pain) \& other single items. For each item,high score represented high level of symptomatology/problem. Last 2 questions represented participant's assessment of overall health \& quality of life, coded on 7-point scale (1=very poor to 7=excellent). EORTC QLQ-C30 observed values and change from baseline for global health status (scoring of questions 29 \& 30) and 5 functional scales, 3 symptom scales and other single items (scoring of questions 1 to 28). Answers were converted into grading scale, with values between 0 and 100. A high score represented a favorable outcome with a best quality of life for participant.

Mean Change From Baseline in HRQL EORTC QLQ-C30 Score: Functional ScalesPre-dose at Baseline, Day 1 of every odd cycle (from Cycle 3 to 35); at EOT (within 30 days of last treatment) (maximum exposure: 214 weeks)

EORTC-QLQ-C30 is a cancer-specific instrument with 30 questions for evaluation of new chemotherapy and provides an assessment of participant reported outcome dimensions. First 28 questions used 4-point scale (1=not at all,2=a little,3=quite a bit,4=very much) for evaluating 5 functional scales (physical,role,emotional,cognitive,social), 3 symptom scales (fatigue,nausea/vomiting,pain) \& other single items. For each item,high score represented high level of symptomatology/problem. Last 2 questions represented participant's assessment of overall health \& quality of life, coded on 7-point scale (1=very poor to 7=excellent). EORTC QLQ-C30 observed values and change from baseline for global health status (scoring of questions 29 \& 30) and 5 functional scales, 3 symptom scales and other single items (scoring of questions 1 to 28).Answers were converted into grading scale, with values between 0 and 100. A high score represented a favourable outcome with a best quality of life for participant.

Change From Baseline in HRQL EQ-5D-3L VAS ScorePre-dose at Baseline, Day 1 of every odd cycle (from Cycle 3 to 35); at EOT (within 30 days of last treatment) (maximum exposure: 214 weeks)

EQ-5D was a standardized HRQL questionnaire consisting of EQ-5D descriptive system and VAS. EQ-5D descriptive system comprised of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression measured on 3 levels (no problem, some problems \& severe problems) within a particular EQ-5D dimension. 5 dimensional 3-level system was converted into single index utility score. The VAS recorded the respondent's self-rated health on a vertical visual analogue scale. The VAS 'thermometer' has endpoints of 100 (Best imaginable health state) at the top and 0 (Worst imaginable health state) at the bottom. This information can be used as a quantitative measure of health outcome as judged by the individual respondents.

Change From Baseline in HRQL EQ-5D-3L Quality of Life: Single Index Utility ScorePre-dose at Baseline, Day 1 of every odd cycle (from Cycle 3 to 35); at EOT (within 30 days of last treatment) (maximum exposure: 214 weeks)

EQ-5D was a standardized HRQL questionnaire consisting of EQ-5D descriptive system and Visual Analogue Scale (VAS). EQ-5D descriptive system comprised of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression measured on 3 levels (no problem, some problems \& severe problems) within a particular EQ-5D dimension. 5 dimensional 3-level system was converted into single index utility score. Possible values for single index utility score ranged from -0.594 (severe problems in all dimensions) to 1.0 (no problem in all dimensions) on scale where 1 represented best possible health state.

Trial Locations

Locations (179)

Investigational Site Number 056004

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Bonheiden, Belgium

Investigational Site Number 840-009

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Farmington, New Mexico, United States

Investigational Site Number 276-005

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Weiden/Oberpfalz, Germany

Investigational Site Number 840-007

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Fountain Valley, California, United States

Investigational Site Number 124001

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Toronto, Canada

Investigational Site Number 840-010

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Howell, New Jersey, United States

Investigational Site Number 124003

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Montreal, Canada

Investigational Site Number 124005

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Montreal, Canada

Investigational Site Number 840-008

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Corona, California, United States

Investigational Site Number 203006

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Zlin, Czechia

Investigational Site Number 124006

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Québec, Canada

Investigational Site Number 003

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Porto Alegre, Brazil

Investigational Site Number 001

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São Paulo, Brazil

Investigational Site Number 840-005

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Middletown, Ohio, United States

Investigational Site Number 203002

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Praha 2, Czechia

Investigational Site Number 203003

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Olomouc, Czechia

Investigational Site Number 840-003

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Lake Success, New York, United States

Investigational Site Number 203001

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Ostrava, Czechia

Investigational Site Number 056007

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Liège, Belgium

Investigational Site Number 276-016

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Aschaffenburg, Germany

Investigational Site Number 840-004

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Riverside, California, United States

Investigational Site Number 004

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São Paulo, Brazil

Investigational Site Number 203004

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Praha 5, Czechia

Investigational Site Number 124004

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Ottawa, Canada

Investigational Site Number 276-012

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Erlangen, Germany

Investigational Site Number 380-023

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Firenze, Italy

Investigational Site Number 380-022

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Napoli, Italy

Investigational Site Number 276-011

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Berlin, Germany

Investigational Site Number 203005

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Brno, Czechia

Investigational Site Number 012

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Fortaleza, Brazil

Investigational Site Number 013

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Sao Jose do Rio Preto, Brazil

Investigational Site Number 276-003

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Lebach, Germany

Investigational Site Number 276-014

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Magdeburg, Germany

Investigational Site Number 124002

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Calgary, Canada

Investigational Site Number 208003

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Hillerød, Denmark

Investigational Site Number 208002

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Odense C, Denmark

Investigational Site Number 276-004

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Halle, Germany

Investigational Site Number 276-001

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München, Germany

Investigational Site Number 276-020

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Wolfsburg, Germany

Investigational Site Number 246001

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Oulu, Finland

Investigational Site Number 380-015

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Milano, Italy

Investigational Site Number 276-019

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Leipzig, Germany

Investigational Site Number 208001

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Cph Ø, Denmark

Investigational Site Number 276-002

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München, Germany

Investigational Site Number 276-010

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Augsburg, Germany

Investigational Site Number 372004

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Galway, Ireland

Investigational Site Number 380-007

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Candiolo, Italy

Investigational Site Number 380-001

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Genova, Italy

Investigational Site Number 380-028

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Novara, Italy

Investigational Site Number 380-003

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Udine, Italy

Investigational Site Number 276-013

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Frankfurt am Main, Germany

Investigational Site Number 372002

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Dublin 24, Ireland

Investigational Site Number 372001

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Wilton, Ireland

Investigational Site Number 380-005

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Ancona, Italy

Investigational Site Number 484009

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Mexico DF, Mexico

Investigational Site Number 380-020

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Terni, Italy

Investigational Site Number 826012

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London, United Kingdom

Investigational Site Number 826011

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Hull, United Kingdom

Investigational Site Number 826004

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Newcastle upon tyne, United Kingdom

Investigational Site Number 380-011

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Roma, Italy

Investigational Site Number 826002

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Southampton, United Kingdom

Investigational Site Number 724005

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Madrid, Spain

Investigational Site Number 764005

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Bangkok,TH, Thailand

Investigational Site Number 764001

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Bangkok, Thailand

Investigational Site Number 752_001

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Växjö, Sweden

Investigational Site Number 826008

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Leicester, United Kingdom

Investigational Site Number 764009

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Chiang Mai, Thailand

Investigational Site Number 826003

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Maidstone,, United Kingdom

Investigational Site Number 826001

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Sutton, United Kingdom

Investigational Site Number 826007

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London, United Kingdom

Investigational Site Number 792-007

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Izmir, Turkey

Investigational Site Number 826006

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Northwood, United Kingdom

Investigational Site Number 826009

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Manchester, United Kingdom

Investigational Site Number 826010

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Taunton, United Kingdom

Investigational Site Number 484010

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México, D.F., Mexico

Investigational Site Number 056010

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Aalst, Belgium

Investigational Site Number 056015

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Arlon, Belgium

Investigational Site Number 056012

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Gent, Belgium

Investigational Site Number 152001

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Santiago, Chile

Investigational Site Number 152003

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Santiago, Chile

Investigational Site Number 246002

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Turku, Finland

Investigational Site Number 376002

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Haifa, Israel

Investigational Site Number 376003

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Tel Aviv, Israel

Investigational Site Number 376001

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Jerusalem, Israel

Investigational Site Number 376004

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Tel Hashomer, Israel

Investigational Site Number 1

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Beirut, Lebanon

Investigational Site Number 484002

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Mexico DF, Mexico

Investigational Site Number 484001

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Monterrey, Mexico

Investigational Site Number 528001

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Hoofddorp, Netherlands

Investigational Site Number 528002

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Zwolle, Netherlands

Investigational Site Number 578001

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Oslo, Norway

Investigational Site Number 764002

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Bangkok, Thailand

Investigational Site Number 764003

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Bangkok, Thailand

Investigational Site Number 764007

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Lopburi, Thailand

Investigational Site Number 764008

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Bangkok, Thailand

Investigational Site Number 764004

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Khon Kaen, Thailand

Investigational Site Number 792-06

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Adana, Turkey

Investigational Site Number 792-01

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Ankara, Turkey

Investigational Site Number 792-08

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Ankara, Turkey

Investigational Site Number 792-02

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Capa, Turkey

Investigational Site Number 764006

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Bangkok, Thailand

Investigational Site Number 792-05

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Gaziantep, Turkey

Investigational Site Number 792012

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Istanbul, Turkey

Investigational Site Number 792-03

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Istanbul, Turkey

Investigational Site Number 380-021

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Bologna, Italy

Investigational Site Number 380-004

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Brescia, Italy

Investigational Site Number 380-012

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Catania, Italy

Investigational Site Number 380-019

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Catanzaro, Italy

Investigational Site Number 380-016

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Messina, Italy

Investigational Site Number 380-013

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Milano, Italy

Investigational Site Number 380-025

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Milano, Italy

Investigational Site Number 380-017

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Padova, Italy

Investigational Site Number 380-002

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Pisa, Italy

Investigational Site Number 380-024

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Roma, Italy

Investigational Site Number 380-010

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Roma, Italy

Investigational Site Number 380-006

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San Giovanni Rotondo, Italy

Investigational Site Number 380-026

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Sassari, Italy

Investigational Site Number 380-009

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Torino, Italy

Investigational Site Number 380-018

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Verona, Italy

Investigational Site Number 006

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Passo Fundo, Brazil

Investigational Site Number 005

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São Paulo, Brazil

Investigational Site Number 276-007

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Krefeld, Germany

Investigational Site Number 276-008

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Ludwigsburg, Germany

Investigational Site Number 276-015

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Northeim, Germany

Investigational Site Number 840-012

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Albuquerque, New Mexico, United States

Investigational Site Number 056009

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Haine-Saint-Paul, Belgium

Investigational Site Number 008

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Brasília, Brazil

Investigational Site Number 011

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Salvador, Brazil

Investigational Site Number 009

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Curitiba, Brazil

Investigational Site Number 002

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Rio de Janeiro, Brazil

Investigational Site Number 276-009

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Frankfurt am Main, Germany

Investigational Site Number 276-018

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Magdeburg, Germany

Investigational Site Number 276-006

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Moers, Germany

Investigational Site Number 276-017

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Velbert, Germany

Investigational Site Number 376005

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Petach Tikva, Israel

Investigational Site Number 380-029

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Bergamo, Italy

Investigational Site Number 380-014

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Meldola, Italy

Investigational Site Number 643005

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Moscow, Russian Federation

Investigational Site Number 380-008

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Reggio Emilia, Italy

Investigational Site Number 578002

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Bergen, Norway

Investigational Site Number 630-001

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Rio Peidras, Puerto Rico

Investigational Site Number 643003

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Kazan, Russian Federation

Investigational Site Number 643001

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Moscow, Russian Federation

Investigational Site Number 643004

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Moscow, Russian Federation

Investigational Site Number 643002

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Moscow, Russian Federation

Investigational Site Number 643006

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Moscow, Russian Federation

Investigational Site Number 643009

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Saint-Petersburg, Russian Federation

Investigational Site Number 724016

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Alicante, Spain

Investigational Site Number 724008

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Barakaldo, Spain

Investigational Site Number 724012

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Cáceres, Spain

Investigational Site Number 724002

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Córdoba, Spain

Investigational Site Number 724013

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Donostia, Spain

Investigational Site Number 724014

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L'Hospitalet de Llobregat, Spain

Investigational Site Number 724003

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Madrid, Spain

Investigational Site Number 724015

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Madrid, Spain

Investigational Site Number 724004

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Málaga, Spain

Investigational Site Number 724010

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Sabadell, Spain

Investigational Site Number 724011

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Santander, Spain

Investigational Site Number 724006

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Santiago de Compostela, Spain

Investigational Site Number 724001

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Valencia, Spain

Investigational Site Number 724009

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Valencia, Spain

Investigational Site Number 724007

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Zaragoza, Spain

Investigational Site Number 752_002

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Jönköping, Sweden

Investigational Site Number 792-09

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Ankara, Turkey

Investigational Site Number 792010

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Edirne, Turkey

Investigational Site Number 792-04

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Istanbul, Turkey

Investigational Site Number 792011

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Izmir, Turkey

Investigational Site Number 826005

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Dudley, United Kingdom

Investigational Site Number 056001

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Edegem, Belgium

Investigational Site Number 056003

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Liège, Belgium

Investigational Site Number 056014

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Loverval, Belgium

Investigational Site Number 056013

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Turnhout, Belgium

Investigational Site Number 056002

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Verviers, Belgium

Investigational Site Number 056011

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Yvoir, Belgium

Investigational Site Number 840-011

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Metairie, Louisiana, United States

Investigational Site Number 840-001

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Rockville, Maryland, United States

Investigational Site Number 764010

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Laksi, Thailand

Investigational Site Number 840-002

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Muscle Shoals, Alabama, United States

Investigational Site Number 840-006

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Indianapolis, Indiana, United States

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